Revised US 'bible' on addictions merges abuse and dependency, suggesting that 10% of Kiwis are affected

Alcohol experts hope more people will get help to reduce their drinking under new medical guidelines that could classify nearly one in 10 New Zealanders as having trouble with the bottle.

The American psychiatric profession's latest edition of its guidelines on the classification of mental illnesses and addictions has changed the way alcohol problems are categorised.

Alcohol "abuse" and alcohol "dependency", previously separate, have been merged in the latest, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - and they are categorised as mild, moderate or severe alcohol "use" disorder.

"It could help clinicians in taking alcohol problems more seriously because it is just one disorder," said Professor Doug Sellman, director of the National Addictions Centre at Otago University. "In the past, people with alcohol abuse were discarded as if that doesn't really count.


"This is a significant disorder, even though the thresholds for having the disorder are quite low - only two out of the 11 criteria. Most drinkers already have tolerance, so you only need one more of the criteria to meet the low threshold for the diagnosis."

"It's clear that people with a mild alcohol problem do recover through moderating their drinking. We're not talking about abstinence from alcohol in people with mild problems. We're talking about a brief intervention and keeping an eye on things."

Professor Sellman said that surveys indicated about 800,000 people in New Zealand were heavy drinkers. He estimated that half would meet two criteria on the DSM-5 list.

This suggests nearly 10 per cent of New Zealanders have at least a mild case of alcohol use disorder.

The DSM-5 is considered the bible of mental health and addictions diagnosis in the insurance-oriented US health system. In New Zealand it has no official status but is used as a guide. The Ministry of Health surveys use a classification system developed by the World Health Organisation.

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Alcohol use disorder is a problematic pattern of alcohol use leading to clinically significant impairment or distress. Manifested by at least two of the following occurring within 12 months:
1. Alcohol often consumed in larger amounts or over a longer period than intended.

2. Persistent desire for, or unsuccessful efforts to cut down or control, alcohol use.

3. A lot of time is spent doing things to obtain alcohol, using alcohol, or recovering from it.

4. Alcohol cravings.

5. Failures to fulfil major obligations at work, school or home because of alcohol.

6. Continuing to use alcohol despite its causing social or interpersonal problems, or making them worse.

7. Important social, occupational or recreational activities are given up or reduced because of alcohol use.

8. Recurrent alcohol use in situations in which it is physically hazardous, such as driving.

9. Continued alcohol use despite having an ongoing physical or psychological problem likely to have been caused or made worse by alcohol.

10. Increasing tolerance to alcohol - needing to drink more to get the same effect.

11. Withdrawal symptoms, relieved by resuming drinking.

Mild case - 2 or 3 symptoms
Moderate - 4 or 5
Severe - 6 or more

- Source: Summarised from Diagnostic and Statistical Manual of Mental Disorders, 5th ed.